Subthalamic deep brain stimulation and trunk posture in Parkinson's disease

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Excerpt

Posture is affected in more than one‐third of patients with Parkinson's disease (PD),1 and trunk posture abnormalities, including stooped posture, camptocormia (CMC),2 and Pisa syndrome (PS),3 represent a major source of functional disability for PD patients.1
Two different, mutually non‐exclusive pathogenic hypotheses have been proposed to explain PD‐associated trunk posture abnormalities4: a central dystonic origin, involving axial muscles and related to the imbalance of basal ganglia network along with altered sensory‐motor integration, and a peripheral musculoskeletal pathology, associated with myopathic changes in paraspinal muscles.4 The role of pharmacological medications remains controversial. While neuroleptics, dopamine agonists, and cholinesterase inhibitors may cause or worsen abnormal trunk postures,9 approximately 20% of PD patients with CMC might receive some benefit from levodopa.12 Preliminary studies with small sample sizes suggest that subthalamic nucleus (STN) deep brain stimulation (DBS) may improve PD‐related trunk posture abnormalities.13 However, data currently available only partially explain the full complexity of STN‐DBS effects on postural changes.
In this study, we sought to clinically evaluate the effect of STN‐DBS on abnormal trunk postures in a large cohort of consecutive PD patients, either alone or in combination with the levodopa effect.
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